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Date_�� PuElm Works Permil• C�O `��� <br /> Application For aiafl.o�oi..��� <br /> I <br /> PUBLIC WORKS PERMIT PueToteFenFee s <br /> Less AoO�Foe Peitl S <br /> Print or Type Only B=�a�=,o�� s �'�— <br /> �i s a h y 9 a-k �[ � .3�l7—`r�ra¢ <br /> /� _7 . �0 �t �p �t C/ [r l, vi . �U C c^G lT �'f,F 7-v a .2.f�1 '� 9 J� <br /> Owner Mailing Address City Zip � Phone <br /> J o vv�.t- <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �w�'4-G t <br /> Project ACdress(if known) �Q '"� �^- o�v � <br /> Attech four(4)copies of plans for proposed work- Draw to scale and note the following as applicab�e: � <br /> • Property Lines • Centerline of street � <br /> � Outline and dimensions of al�existing and � Indicate North <br /> . proposed structures on the lot • Show any proposed gradiog changes <br /> • Existtng and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PER�.11T CONDITIONS � <br /> t.All cells for Inspection shall be made 24 hrs.in advance-phone 259•8610. � <br /> 2.All work shell be peAormed in accordance with this permit and currenl City of Everetl Oesign and Const�uction <br /> Standards and Specifications. <br /> 3.Call Lxetfon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ACK�'OWLEDGEMENT OF CONDITIONS <br /> r The undersigned owner/applicant hereby agree�to hold and save harm• <br />'� less the City ol Everett irom any anA all claims for damages, costs, <br /> ezpenses, or causes of action that may arise because of installation <br /> O and maintenance of the improvement or other right-of-way use hereto <br /> roved for Const�uct applied for and lurther agrees to remove same upon notice irom the <br /> ' Date City and to replace public property damaged thereby. <br /> i �U-C� �L <br /> �. L INSPECTI N Date <br /> � oved as Constructed ignature ol Appli artl' Date <br /> , tt PUBLICWORKSDEPARTMENT WORK AUTHORIZED . THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> �� Everett WA 98201 BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />